Antibiotics in surgical wards: use or misuse? A newly industrialized country’s perspective

  • Mun Kit Lim University of Malaya, Kuala Lumpur, Malaysia
  • Pauline Siew Mei Lai University of Malaya, Kuala Lumpur, Malaysia
  • Sasheela Sri La Sri Ponnampalavanar University of Malaya, Kuala Lumpur, Malaysia
  • Sharifah Faridah Syed Omar University of Malaya, Kuala Lumpur, Malaysia
  • Nur Aishah Taib University of Malaya, Kuala Lumpur, Malaysia
  • Mohamad Yasim Yusof University of Malaya, Kuala Lumpur, Malaysia
  • Claire Marie Italiano Royal Perth Hospital, Perth, Australia
  • David Chee Ming Kong Monash University, Victoria, Australia
  • Adeeba Kamarulzaman University of Malaya, Kuala Lumpur, Malaysia
Keywords: antibiotic stewardship, surgical, appropriateness, antibiotics, Malaysia

Abstract

Introduction: Studies exploring the appropriateness of therapeutic antibiotic use among surgical patients are limited, particularly in developing countries. Therefore, the aim of our study was to determine the appropriateness of antibiotics prescribed in a surgical setting in Malaysia.

Methodology: A prospective observational study was conducted in two surgical wards at a tertiary hospital in Malaysia from November 2012-July 2013. Data was collected using a case report form. The appropriateness of antibiotic therapy was based on compliance with either the Malaysian National Antibiotic Guidelines 2008 or International Clinical Practice Guidelines and determined by an expert panel (consisting of two infectious disease consultants and a pharmacist).

Results: Over the study period, a total of 593 antibiotic courses were prescribed for 129 patients (4.6±3.4 antibiotics/patient). Only 34 (26.4%) patients received appropriate antibiotic therapy, whilst 95 (73.6%) patients received at least one course of inappropriate antibiotic therapy. The prevalence of inappropriate antibiotic use was 214 (66.3%) and 55 (42.0%) for prophylactic and therapeutic purposes, respectively. The most common causes of inappropriate prophylactic antibiotics were inappropriate timing 20 (36.4%) and inappropriate duration of prophylaxis 19 (34.5%). In cases of inappropriate timing, 9 (45%) were administered too late while 6 (30%) were too early. . In contrast, inappropriate choice of antibiotics (42.1%) and inappropriate indication (40.7%) were the most common reasons encountered for inappropriate therapeutic antibiotics.

Conclusion: Our study suggests considerable inappropriate use of both prophylactic and therapeutic antibiotics in the surgical wards; highlighting an urgent need for antibiotic stewardship initiatives in this setting.

Author Biographies

Mun Kit Lim, University of Malaya, Kuala Lumpur, Malaysia
Department of Primary Care Medicine
Pauline Siew Mei Lai, University of Malaya, Kuala Lumpur, Malaysia

Senior Lecturer

Department of Primary Care Medicine

Sasheela Sri La Sri Ponnampalavanar, University of Malaya, Kuala Lumpur, Malaysia

Associate Professor

Department of Medicine (Division of Infecitous Disease)

Sharifah Faridah Syed Omar, University of Malaya, Kuala Lumpur, Malaysia

Senior Lecturer

Department of Medicine (Division of Infectious Disease)

Nur Aishah Taib, University of Malaya, Kuala Lumpur, Malaysia

Professor

Department of Surgery

Mohamad Yasim Yusof, University of Malaya, Kuala Lumpur, Malaysia

Associate Professor

Department of Medical Microbiology

Claire Marie Italiano, Royal Perth Hospital, Perth, Australia

Infectious Disease Consultant

Department of Microbiology and Infectious Diseases

David Chee Ming Kong, Monash University, Victoria, Australia

Senior Lecturer

Centre for Medicine Use and Safety

Adeeba Kamarulzaman, University of Malaya, Kuala Lumpur, Malaysia

Dean and Professor

Department of Medicine (Division of Infectious Disease)

Published
2015-11-30
How to Cite
1.
Lim MK, Lai PSM, Ponnampalavanar SSLS, Syed Omar SF, Taib NA, Yusof MY, Italiano CM, Kong DCM, Kamarulzaman A (2015) Antibiotics in surgical wards: use or misuse? A newly industrialized country’s perspective. J Infect Dev Ctries 9:1264-1271. doi: 10.3855/jidc.6731
Section
Brief Original Articles